Feb. 12, 2025
In this article, Wayne Street, M.S.N., R.N., trauma program manager for Northwest Wisconsin - Trauma Service and a member of Mayo Clinic's PTSD work group, responds to questions about the group's efforts to meet the mental and emotional needs of adult patients who have experienced traumatic injury. The work group's official name is the Trauma Quality Improvement Program Mental Health Pilot Project for Rochester and Eau Claire.
Why was this group charged with addressing the mental health needs of adult patients who've experienced traumatic injury?
About 3 to 4 years ago, focusing on the mental health needs of patients we see for trauma care became a national initiative through the American College of Surgeons. Trauma and mental health experts explored issues our patients might experience and how we might tackle those issues. An assessment of how we're meeting our patients' mental health needs is now part of our verification process.
The experts felt we needed to address post-traumatic stress disorder (PTSD) and depression, specifically, for patients who've experienced trauma. This would allow us to not only save lives but also improve patients' lives. Both depression and PTSD can arise because of experiencing severe trauma or witnessing it.
Can you provide an example of how PTSD might arise for those involved in a traumatic event?
Yes. Let's say a husband and wife, married many years ago, experienced a bad car crash on a country road. As they remained trapped in the car, the wife watched her husband die while waiting for the EMS. The wife later experienced stress, anxiety, sleepless nights, and obsession with the memory of the crash and her husband's death.
Do all patients who experience traumatic injury experience PTSD?
No. Most trauma patients resume life as usual in 3 to 6 months and are no longer haunted by the traumatic event. However, someone who develops PTSD after trauma cannot move beyond the haunting of that traumatic event and needs intervention.
We are trying to identify which patients who experience traumatic injury will later develop PTSD.
What actions are being taken by the work group to screen patients for future PTSD or depression following a traumatic event?
During hospitalization, we identify which patients are at the highest risk of PTSD or depression and plug them into inpatient and outpatient mental health services, working in collaboration with social workers and case managers. For patients we deem to be at low risk of PTSD or depression, we provide educational resources in case PTSD or depression arises. We talk about signs to watch for and what outpatient resources are available.
Froedtert and the Medical College of Wisconsin developed the Injured Trauma Survivor Screen, which we used as a model for adult patients. This institution had great success with this tool, and healthcare professionals there published a six-month follow-up in a 2018 issue of Trauma and Acute Care Surgery. We use a different screening tool for pediatric patients.
After obtaining institutional permission, our group built the screening tool in EPIC to trigger a best-practice alert for case managers and social workers for patients who've experienced traumatic injuries.
The tool, which is presented as a flow chart, went live for Mayo Clinic and Mayo Clinic Health System in August 2024. We now have a data management plan for a practice change to implement this screening for the ICU and the general care and trauma units. We then conducted a review in September 2024 to find out which trauma centers were using the tool.
What data or anecdotal evidence has the group collected so far about the outcomes of the screening?
There is no postoutcome study planned right now. However, social services staff have provided anecdotal evidence that patients and their loved ones benefit from the conversation during the screening administration.
After formal training with the screening tool, we implemented it in a feasibility study in the spring of 2024 including a trigger for a consult screen. We trialed and implemented the screening for all red and yellow trauma patients. This was a precursor project to the American College of Surgeons (ACS) mental health and trauma screening project.
We completed a feasibility study write-up, and the feedback we received from healthcare professionals was that adding this screening tool was not an incredible work burden. At the same time, the tool helped them bridge to conversation about patients' and their loved ones' post-traumatic mental health.
The goal for those who demonstrate a high risk of PTSD or depression is to match them with the appropriate outpatient services for their needs and insurance, such as the patient's primary care team, an outpatient psychiatric clinic or a community health clinic.
What excites you about this project?
I'm happy that this screening not only meets the ACS objectives but is also good for our patients. Now, patients at high risk will not be sent home to figure out life on their own.
What trauma centers have access to this mental health screening tool?
It's available to all trauma centers at all levels. The screener is available on EPIC for Mayo Clinic Health System sites, and it's also available on the internet for free.
It's great that this is available, as there aren't many screeners available to assess patients for PTSD or depression risk.
Do you have any other thoughts to share on this topic?
I'd say that awareness of mental health concerns is on the rise. Finding ways to be mindful of the impact of traumatic events and building further awareness is important.
For more information
American College of Surgeons: Trauma Programs. Best practice guidelines: Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient.
Hunt, JC, et al. Six-month follow-up of the injured trauma survivor screen: Clinical implications and future directions. Trauma and Acute Care Surgery. 2018:85:263.